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Approach to bleeding disorders

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M
Manoj Madakshira Gopal

This document provides guidance on evaluating a patient with a suspected bleeding disorder. It emphasizes taking a thorough bleeding history and family history as the most important screening tools. The bleeding history should detail the type, frequency, severity and provoking factors of any bleeding episodes, as well as treatment received. A physical exam looks for signs of bleeding, joint issues, organ enlargement or trauma. Laboratory tests that may be ordered as part of an initial screening include a complete blood count, platelet function analyzer test, prothrombin time and activated partial thromboplastin time. These basic tests can help identify possible causes of bleeding and guide decisions about further testing or diagnosis.

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How to approach a patient with suspected bleeding disorder?
Many Possibilities !
Suspected bleeding disorder ? Bleeding history ?
Bleeding history • Type and frequency of bleeding • Provoked or unprovoked • Type of treatment • Family history (family tree) • Drug history
Bleeding history • Usually clear in patients with severe bleeding disorders • In patients with mild/moderate bleeding symptoms a standardized questionnaire is helpful • Standardized scores to quantitate bleeding symptoms
Suspected bleeding disorder Bleeding history ? Physical examination
Physical Examination • Inspection for any bleeding signs • Joint abnormalities • Lymphadenopathy • Organomegaly • In children: signs of non-accidental trauma!
Suspected bleeding disorder Bleeding history ? Physical examination Laboratory screening
Decision to order screening tests
Decision to order screening tests
Very Important to remember ! • Thorough personal and family histories are the best screening tests for identifying potential hemostatic problems. • Properly obtained histories eliminate the need for laboratory screening procedures.
What screening tests to order ? • CBC – Complete blood count • PBS – Peripheral blood count • Platelet Function Analyser • Prothrombin Time • Activated Partial Thromboplastin Time
CBC/PBS • Gives a snapshot of the hematological parameters • RBC indices • TLC / DLC • Plt count, MPV and PDW • Platelet size and morphology
CBC/PBS - Pitfall • Pseudo- thrombocytopenia • EDTA-induced agglutination of platelets • Confirmed on PBS
Finger prick smear
PFA
PFA False positive if PCV <35
Decision time !
Decision time !
Possible DDs
Decision time !
Isolated thrombocytopenia
Decision time
PT verus APTT
Possible DDs
Summary • Index of suspicion • History – most important • Examination • Screening tools – CBC /PBS – PFA – PT / APTT
Thank you !

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Approach to bleeding disorders